NPI | 1063001220 |
---|---|
Entity Type | Organization |
Authorized Contact | SEAN ST. PATRICK MAXWELL Executive Director 747-272-9348 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
Enumeration Date | 2021-01-12 |
Last Update Date | 2021-01-12 |